title: The dynamic triple peak impact factor in traumatic brain injury influences native protein structures in gray and white matter as measured with computational simulation.
abstract: BACKGROUND
  Traumatic brain injuries (TBIs) cause a substantial burden to the patient, relatives, and the society as a whole. Much experience and knowledge during the last two decades have improved the neurosurgical treatment as well as the outcome. However, there is still much debate on what actually happens when external kinetic energy is transferred to the head immediately after a TBI. Better knowledge about the cascades of mechanical events at the time of accident is a prerequisite to further reduce the burden in all categories and improve the neurosurgical care of TBI patients.
  
  
  METHODS
  In the present study, we use the finite element modeling of the human brain to numerically simulate impact velocities of 10, 6, and 2 m/s to clarify some of the immediate consequences of the external kinetic energy transfer focusing on the gray (GM) and white matters (WM).
  
  
  RESULTS
  The numerical simulation was focused on the external kinetic energy transfer with a level of 227·3 J reaching the head, intracranial pressure (ICP), strain energy density, 1st principal strain level, and their respective impacts on the brain tissue. The results show that, for a 10 m/s impact, a total internal potential energy of 208·6 J was absorbed, of which 14·3% (29·81 J) was absorbed by the scalp, 22·05% (46·0 J) by the outer compact bone, 17·12% (35·72 J) by the porous bone, 27·44% (57·23 J) by the inner compact bone, and 7·31% (15·24 J) by the facial bone. The rest of the internal potential energy was defined to reach the GM (3·6%, 7·51 J) and the WM 1·59% (3·31 J). Also, the ICP, strain energy density, and 1st principal strain levels, defined as the dynamic triple peak impact factor, influenced the GM and WM with their own impact peaks during the first 10 ms after the accident and were the highest for the 10 and 6 m/s impacts, while the 2 m/s impact had only a slight influence on the GM and WM structures.
  
  
  CONCLUSIONS
  The present study shows for the first time that following an impact of 10 m/s, 88·31% of the calculated external kinetic energy was absorbed by the external parts of the head before the remaining energy of 5·19% reached the GM and WM. GM absorbed about twice as much of the energy compared to the WM. It is suggested that the dynamic triple peak impact factor may have a profound effect on native protein structures in the cerebral metabolism after a TBI.
authors.affiliation: Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hans von
authors.initials: Hv
authors.lastname: Holst
authors.forename: Xiaogai
authors.initials: X
authors.lastname: Li
mesh_terms: D001930:Brain Injuries / Q000378:metabolism*; D003198:Computer Simulation; D004735:Energy Transfer; D020342:Finite Element Analysis; D006257:Head; D006801:Humans; D007427:Intracranial Pressure; D009413:Nerve Fibers, Myelinated / Q000378:metabolism*; D036421:Nerve Fibers, Unmyelinated / Q000378:metabolism*; D009419:Nerve Tissue Proteins / Q000737:chemistry* / Q000378:metabolism*
chemical_list: D009419:Nerve Tissue Proteins